Three-dimensional laparoscopy: Principles and practice

Abstract

The largest challenge for laparoscopic surgeons is the eye-hand coordination within a three-dimensional (3D) scene observed on a 2D display. The 2D view on flat screen laparoscopy is cerebrally intensive. The loss of binocular vision on a 2D display causes visual misperceptions, mainly loss of depth perception and adds to the surgeon's fatigue. This compromises the safety of laparoscopy. The 3D high-definition view with great depth perception and tactile feedback makes laparoscopic surgery more acceptable, safe and cost-effective. It improves surgical precision and hand-eye coordination, conventional and all straight stick instruments can be used, capital expenditure is less and recurring cost and annual maintenance cost are less. In this article, we have discussed the physics of 3D laparoscopy, principles of depth perception, and the different kinds of 3D systems available for laparoscopy. We have also discussed our experience of using 3D laparoscopy in over 2000 surgeries in the last 4 years.

Figure 1

Stereoscopic vision: The perception of depth and three-dimensional structure is obtained on the basis of visual information derived from both eyes by processing the binocular disparities in the visual cortex

Figure 2

Physics of a three-dimensional telescope: The telescope has two optical channels that carry two separate images which are fused together to produce a single binocular vision with depth perception

Figure 3

Telescope showing two optical channels

Figure 4

Operation theatre set up with surgeons wearing three-dimensional glasses: The central monitor is three-dimensional monitor and the right and left monitors show the right and left eye vision, respectively. Surgeons have to wear polarised glasses to view a three-dimensional picture on the monitor